Obstetric Learning Lab 2
Infant Feeding
Introduction:
This lab will focus on breast feeding and nursing interventions to assist the childbearing family with
breast feeding.
Lab Preparation:
Read McKinney. Ch 24
*Print copy of this and bring to lab.
Learning Objectives:
Utilizing critical thinking and the nursing process, the student is expected to:
1. Identify positions of the mother and infant for breast feeding.
Cradle Football
Side-lying
Position of the mother’s hand – C position
2. Discuss latch-on techniques.
3. Describe suckling patterns.
4. Describe how to avoid trauma to the breast when removing the baby from
the breast.
5. Discuss length and frequency of feedings.
6. Discuss common breast feeding problems and nursing interventions including:
Sleepy infant Nipple confusion
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Infant sucks on the end of the nipple and does not open mouth widely
Nipples are inverted or flat
Breast are hard and tender from engorgement
Nipples are sore, cracked, blistered, or bleeding
7. Describe methods of expressing milk from the breasts – manual and electric
breast pumps.
8. Discuss methods to assist the mother with weaning.
Learning Resources:
McKinney. Maternal-Child Nursing. Ch. 24.
Video – Breast Feeding (will be shown in lab)
Notes
Infant Feeding
Introduction:
Choosing a method of feeding is an important decision for parents to make. The choice is influenced by
physical, psychological, and social factors. It is the nurse’s responsibility to assist the parents to make
this decision by presenting the benefits and possible contraindications to the types of feeding methods
and to answer any questions.
Even though breast feeding is considered the preferred method of feeding for infants up to 4 to 6
months of age, the nurse must keep biases out of the way and present information on both breast and
bottle feeding and allow the parents to make the decision that is most suitable for them.
Breast Feeding
If the new mother chooses to breast feed, her successfulness is often influenced by her care in the
hospital. It is important to encourage this process and assist her as necessary.
Assessment:
A complete assessment is essential to determine the mother’s level of knowledge and to detect any
actual or potential problems. Some factors to assess include:
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Mother’s previous experience with breast feeding
Mother’s knowledge about breast-feeding
Assessment of the infant’s current condition
Assessment of the mother-infant interaction
It is important to assess the newborn at the breast. The four main areas of infant behavior to assess
include:
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Alignment
Areolar grasp
Areolar compression
Audible swallowing
Nursing Diagnosis:
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Knowledge deficit about breast-feeding RT
Ineffective breastfeeding
Planning and Intervention:
Initiation of Breast-Feeding:
The first hours after birth are generally an excellent time for the initiation of breast-feeding. The
newborn is usually awake and alert for the first hour or so and is ready to suck.
Positioning of the Mother and Infant:
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New mothers need to know about the various positions for breast-feeding. Varying the nursing
positions changes the position of the infant’s mouth on the nipple and promotes more complete
emptying of the breast. This can prevent the nipples from becoming tender and the ducts
becoming plugged. Positions for the mother include:
Sitting up – if in bed, high fowlers position with knees bent. May want to sit up in a chair. Always
place a pillow under the arm that is supporting the newborn.
Side-Lying – mother is on her side with her arm raised and her head comfortable supported.
Positions for the Infant:
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Cradle hold – place the baby’s head in the bend of the arm with the buttocks or upper thigh
cradled in the hand. Position the baby well over on his side, completely turned toward the
mother. Pull the baby tightly against the body (tummy to tummy). The baby’s lower arm should
be around the mother’s waist. Make sure the baby’s hip and shoulder is in alignment. Use
pillows to elevate the infant to the level of the nipple and prevent pulling and tension on the
nipple.
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Football hold – Lay the baby on the arm nearer the breast with his head in the mother’s hand
and the baby’s body beside her. The baby will be tucked up under the mother’s arm with her
hand positioning his shoulders and hand. The baby is facing the breast.
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Side-Lying – put the baby on his side facing the mother. The mother’s arm cradles the baby close
to her and guides his head.
Assisting with Latch On:
1. Hold the breast in the hand opposite the breast. Put the hand in the C hold with the thumb on top
and all four fingers and the palm of the hand under the breast to support it at the baby’s lower lip. Have
the fingers far enough back from the nipple and areola that the baby can get the nipple well into his
mouth. Hold the breast for the baby unless it is obvious that he doesn’t need help.
2. Stroke / brush the baby’s lips to elicit rooting. (stroking the lower lip or chin will sometimes get the
baby to open wider). The baby will respond by opening the mouth. When the mouth is opened wide, the
mother should quickly bring the infant close to her so that the infant can latch on to the areola. Be
careful not to touch any other part of the baby’s head which might confuse him and cause rooting in
several directions.
3. Get the nipple and enough of the areola into the baby’s mouth to allow the jaw to compress the
sinuses, which are behind the nipple and under the areola. Aim the nipple to the back of the mouth and
the baby’s tongue will come out to pull in the nipple toward the back of the mouth.
4. Correct positioning is when the mouth is opened wide and the lips are flared outward. The tongue
forms a trough under the nipple and areola and extends beyond the lower gum. If there is doubt about
tongue placement, gently pull down on the infant’s lower lip and observe. The infant’s nose and chin
should lightly touch the breast.
Milk pools in the lactiferous sinuses under the areola, which is compressed between the baby’s tongue
and palate during nursing. The nipple itself must not be compressed because it serves as a channel
through which milk flows in to the baby’s mouth.
Suckling Patterns:
If the infant has a good grasp on the breast, the jaws move up and down regularly and swallowing
movements can be seen in the infant’s throat. Swallowing sounds can be heard. During nutritive
suckling, the infant sucks with smooth, continuous movements with only occasional pauses to rest. Each
suck may be followed by a swallow, or two or three sucks then a swallow. Nonnutritive sucking is usually
when the infant is falling asleep. There is choppy motion of the jaw that is not accompanied by the
sound of swallowing. If the grasp is poor, there may be clicking or smacking sounds. With ineffective
sucking or falling asleep, remove the baby from the breast.
Removing the Infant from the Breast:
To break the suction, the mother inserts her finger into the corner of the infant’s mouth between the
gums. She then removes the breast quickly before the infant begins to suck again.
Feeding Times:
Infants usually feed every 2 to 3 hours. The stomach empties within 1.5 to 2 hours. Frequent feedings
are important the first few days until lactation is established. The baby’s sucking stimulates the
secretion of prolactin which causes the milk glands to produce milk. This fact explains why breastfeeding
works on a supply meets demand system. Each time the baby nurses, more milk is made in response to
the emptying of the milk glands. Frequent nursing increases milk supply. The mother should wake the
infant up for feedings because long periods between feedings increase the incidence of breast
engorgement.
Feedings are no longer timed. It may take as long as 5 minutes for the milk-ejection or let-down reflex to
occur. The let-down reflex occurs from the suckling stimulation of the nipples which in turn causes the
pituitary gland to secrete oxytocin. This hormone is responsible for let-down reflex during which the
milk ejecting cells contract and force the colostrums, and later the milk, from the milk producing cells
into the milk ducts. Feedings times average 15-20 minutes per breast and will increase over the next few
days. The mother should feed on one side as long as the infant nurses vigorously before burping and
continuing on the other breast. Count feeding times from beginning to beginning.
Foremilk is the watery first milk that quenches the infant’s thirst, and hindmilk is the milk that is rich in
fat and is more satisfying and lead to weight gain. Feeding for too short a period will not let the baby get
the hindmilk and decreases weight gain.
How to Tell that the Infant is Getting Enough:
1. Hearing the baby swallow frequently during
feedings.
2. The breasts get softer during the feeding
3. You can see milk in the infant’s mouth
4. The baby has at least 2-6 wet diapers a day for the first 2 days and 6-10 wet diapers per day
by the fifth day.
5. The baby passes three bowel movements or more during the first month. The stool is yellow
by the end of the first week
Common Breast Feeding Problems and Solutions:
1. Sleepy Infant
a. Gently move the infant’s arms and legs and play with the infant before beginning the feeding.
b. Unwrap baby and change the diaper.
c. Wash the baby’s face with lukewarm washcloth.
d. Rub the infant’s hair or cheek gently, stroke around mouth or shift position.
e. If the baby cannot be awakened, allow to sleep for 30 more minutes and try again.
2. Nipples are sore, cracked, blistered or bleeding
a. Do not use soap on the nipples. Apply colostrum at the end of each feeding.
b. Make sure the infant’s mouth is positioned correctly on the breast so that baby is not chewing
on the nipple.
c. Change feeding positions with each feeding so that different areas of the nipple are subjected
to the stress from sucking.
d. Avoid engorgement by nursing frequently so the infant can grasp the nipple.
e. May use nipple creams.
3. Engorgement
a. Breast feed more often, every 2-3 hours around the clock.
b. Apply cold packs to the breasts between feedings.
c. Apply cold cabbage leaves.
d. Apply warm packs just prior to feeding to stimulate milk flow.
e. Massage the breasts before and during feedings.
f. Express a little milk before feeding.
g. Wear a well filling bra day and night.
4. Nipple confusion
a. Avoid use of bottles or pacifiers.
b. Avoid giving supplemental feedings at the end of breast feeding.
5. Flat / Inverted nipples
a. Wear breast shells in bra to help make the nipples protrude.
b. Just before feeding, roll the nipple between thumb and forefinger to help it protrude.
c. Apply nipple shield or use a breast pump to draw out the inverted nipple.
6. Infant does not open mouth and suck on the end of the nipple
a. Do not insert the breast into the infant’s mouth until the infant opens the mouth wide. May
just have to wait.
b. Pull down gently on the infant’s chin to help the infant open the mouth if necessary.
7. Not enough milk
a. Put the baby to breast more often
b. Get more rest
c. Increase fluid and protein intake
d. Supplement with supplement device while breast feeding. The device consists of a pouch that
delivers milk to the infant through a tube that enters the infant’s mouth next to the mother’s
nipple.
General Care during Breastfeeding:
Care of the Breasts:
Cleanliness is important, but it is the hands that need washing, not the nipples. Wash breasts with water
only so the natural oils are not removed. Air dry the nipples after each feeding and express colostrum on
the nipples and allow drying. Colostrum is soothing and healing. Wear nursing bra. If there is a leakage
of breast milk, breast pads can be worn. These must be changed frequently when they get damp.
If the mother is leaking during let-down (either on the opposite breast while the baby is nursing or on
both breasts when not nursing) teach her to push straight back to the chest wall on the breast. The
mother can do this discreetly. it is not unusual for the breasts to leak during intercourse. Nursing
beforehand can decrease the chances of this happening.
Rest:
Rest is very important to the breastfeeding mother. If the mother does not get adequate rest, her milk
supply will decrease. Active women may need help realizing the importance of naps and rest periods.
Diet:
The diet does not change during breastfeeding, just has additions. There is a need for more calories,
vitamin A and C, niacin, and riboflavin. A high fluid intake is necessary for milk production. Fluid intake
between 2,500 and 3,000 cc is recommended.
Mothers may have heard that certain foods should be avoided during lactation. Although some infants
may be bothered by specific foods the mother eats, this is not universally true. Most mothers can eat
any nutritious food without causing the infant distress. Food affects the milk 4- 24 hours after it is eaten.
If the baby seems to be upset after eating a certain item, think back to what was eaten, then avoid it.
Caffeine, nicotine, alcohol, and drugs all go through milk in varying quantities and with varying effects
and should be avoided as much as possible.
Bottle Feeding
Types of Formula:
Formula may be purchased in three different forms:
· Ready-to-Use Formula - does not have to be diluted with water and can be used as is.
Expensive, but easy to use.
· Concentrated liquid - need to explain how to dilute with equal parts of water from a safe
source.
· Powdered Formula - economical, need to explain how to dilute in warm water from a safe
source. Formula should be well mixed to dissolve the powder and make the solution uniform.
Positioning and Grasp:
Should be in a semi-upright position as in the cradle hold. This allows the mother to hold the baby close
with face-to-face contact. The bottle is held so that the nipple is kept full of formula to prevent excessive
swallowing of air.
Gently stroke the infant’s lips with the nipple. Wait until the infant opens its mouth wide enough so that
the tongue can be seen and place the tipple on top if the tongue.
Burping:
Burping the infant after every ounce is needed for the first few days. Place the infant over shoulder or in
a sitting position with the head supported while she pats and rubs the infant’s back
Frequency and Amount:
Feed the baby every 3 -4 hours. The infant will take about 1 ounce the first day but can gradually
increase to 2 - 3 ounces by the third day. Both the frequency and amount need to be adjusted to the
needs of the infant.
Cautions:
1. Do not prop the bottle - propping increases the chances of choking if regurgitation occurs and
eliminates the cuddling and holding that should accompany feeding. Ear infections are more
common in infants who sleep with a bottle propped.
2. Do not coax the baby to finish the bottle at each feeding.
3. Discard unused formula at the end of the feeding.
4. When heating the formula, microwave heating is not encouraged because
of the uneven heating. Be sure to test the formula temperature by
allowing a few drops from the bottle to fall on the inner arm.